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Monday, 7 May 2012

1.4 - Schizophrenic or Saint?

Anorexia is a disorder associated in the popular mind with a specific symptom. Schizophrenia, on the other hand, has a far more widely-ranging effect on human behaviour, and is generally much more closely associated with ‘madness’. Like anorexia, its definition and name are of relatively recent origin, although it has been known for centuries, and its association with mysticism has been investigated by scholars from many disciplines. The areas of overlap between mystical and schizophrenic behaviour has been the subject of intensive recent research by psychologists interested in the light which the latter can shed on the examples of mystical experience with psychotic episodes to discover the extent to which it would be legitimate to describe medieval mystics as ‘schizophrenic’ in the modern sense of the word.

Schizophrenia, from the Greek root schizein (to split), and phren (mind), is a psychiatric diagnosis that describes a mental illness characterized by impairments in the perception or expression of reality, most commonly manifesting as auditory hallucinations, paranoid or bizarre delusions or disorganised speech and thinking in the context of significant social or occupational dysfunction.[1] Men and women are equally afflicted with schizophrenia: ‘[the] onset of symptoms typically occurs in young adulthood,with approximately 0.4–0.6 percent of the population affected’.[2] Diagnosis is based in part on clinical observation and in part on the patient’s subjective symptoms.

The schizophrenic patient’s perceptions of the world – of feelings, relationships, social situations, even of time and space – are often radically different from that of non-patients. Their thought processes and means of expression may be hectic and disjointed, difficult to communicate, and sometimes wildly at odds with the conventional. ‘It is a disease, that makes it difficult for a person to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses to others, and to behave normally in social situations.’[3] Sometimes during such schizophrenic behaviour the mind will go completely blank. As a result, his behaviour may seem at best inappropriate, and worst threatening and dangerous.

Although the name Schizophrenia was coined less than a hundred years ago, the symptoms of the condition have been known for millennia. There are written records from the Pharaonic era which contain recognisable descriptions of the illness, and in the Book of Hearts (in the Ebers Papyrus, which dates back to c.1550 BC) are found early descriptions of the dementia, depression, and disturbed thought processes, typical of schizophrenia. In considering mental illness, ancient Egyptians did not differentiate between the roles of ‘mind’ and ‘heart’. They traced pathological and physical disorders to the circulatory system, although demons and poisons could also be held responsible.

Greek and Roman literature also contain descriptions of what might be regarded as symptoms of schizophrenia, although physicians had not identified a constellation of such symptoms as a separate disease in a way that would approach modern-day diagnostic criteria.

Mental illness has long been associated with demonic possession. Ancient skulls have been found with holes bored in them, which archaeologist have conjectured were drilled in order to release 'demons' – i.e. the occult causes of madness. This trepanning (or trephining) was a evidence of early theorists’ belief in a concrete cause for the disease; better-known today (and more consistent with the disease’s spiritual origin) is the exorcism that commonly resulted from belief in a demonic origin. Even today in Switzerland there is a strict religious sect that believes that the disease has such an origin.[4]

The very concept of insanity has not been without controversy; R. D. Laing famously defined it as ‘a perfectly rational adjustment to the insane world’.[5] Nevertheless, in one form or another mental illness has been acknowledged since Biblical times; when Saul suffered from bouts of depression, David was sent for to play the harp to him, ‘and the evil spirit departed from Saul’.[6] Dr Emile Kraepelin was the first to identify schizophrenia as an individual disorder. In 1887 he distinguished between those psychiatric disorders that were marked by a condition he called dementia praecox (otherwise known as pre-senile dementia or premature dementia, a condition which shared many symptoms in common with schizophrenia), and manic depression. Because classic dementia was one of a group of diseases primarily associated with the elderly[7], it was necessary to re-define dementia praecox. Bleuler considered Krapelin’s definition was unhelpful because it focussed attention on the age-related aspect of the condition; further, unlike senile dementia, dementia praecox did not necessarily lead to mental deterioration. Accordingly, Bleuler coined the word schizophrenia.

Many notable mystics have been considered insane (or schizophrenic by contemporary physicians), or subject to angelic or demonic possession, including Theresa of Avila, John the Baptist and even Jesus himself. The prophet Ezekiel is also considered to have been an early schizophrenic – c.f. his visions, and his claim to have been divinely instructed to lie on his right side for three hundred and ninety-nights, before changing to his left for a further forty. In medieval Europe, Joan of Arc was the best known of a number of visionaries whose ‘voices’ led them to be charged with demonic heresy and burned at the stake, while Margery Kempe was another famous example.

There is a longstanding association in psychiatric literature between mental illness and mysticism, wherein schizophrenia and mysticism have been looked upon in a similar way to madness and genius – they seem to be closely related, yet fundamentally different. Arieti found difficulty in distinguishing the psychotic and mystical states: ‘It is easy to confuse religious mystics with psychotic patients, especially those psychotics who have hallucinations and delusions with religious content'.[8] (However, it should be noted that this quotation implies that there is a difference.) This similarity has led to two general conclusions about the schizophrenic and mystic states: first, those who look upon schizophrenia as a wholly undesirable illness, tend to categorise mysticism similarly: 'The psychiatrist will find mystical phenomena of interest because they can demonstrate forms of behaviour intermediate between normality and frank psychosis; a form of ego regression in the service of defence against internal or external stress.'[9]

Critics have argued for the fact that true regression can and does occur, and that some alleged mystics are actually trapped in this regressive state. However, this should not obscure the difference between schizophrenia and mysticism, and as a result the above blanket statement on the nature of transcendence and mysticism proves to be of quite limited help.

Individuals of the second attitude tend to view schizophrenia, not as a pathological sickness, but as ‘super-healthy’. I believe that this second attitude towards schizophrenia and mysticism is closer to the truth, although it can be seen as dogmatic and over-compensating as the first. Critics such as Brown and Laing are sympathetic to the notion that transcendent states are ultra-real, and since schizophrenic and mystic states are so similar, the schizophrenic must therefore necessarily be an example of complete health. Brown states,

It is not schizophrenia but normality that is split-minded; in schizophrenia the false boundaries are disintegrating. Schizophrenics are suffering from the truth. The schizophrenic world is one of mystical participation; an ‘indestructible extension of inner sense’; ‘uncanny feelings of reference’; occult psychosomatic influences and powers .[10]

In addition, with reference to the chaotic and confusing world in which we live in, Pascal states: ‘Human beings are so necessarily mad that not to be mad would amount to another form of madness'.[11] Alexander, Freud and Menninger suggest that mysticism is a subspecies of mental disease – possibly schizophrenia. Because of the heightened awareness of their surroundings demonstrated by many schizophrenics, some writers have claimed a mystical status for the disease, going so far as to say that schizophrenia is actually a positive or beneficial state.[12] This appears to be a piece of ‘special pleading’ for the disease, and although it is part of an understandable attempt to de-stigmatise it, this essay treats it as an illness and a misfortune.

In 1902 James distinguished between two kinds of mysticism in relation to the similarity between the mystic and schizophrenic experience: a higher and a lower. The former included the classic religious experiences, while the latter, which he defined as ‘diabolical mysticism’,[13] denotes mystical ideas which should be understood as examples of insane behaviour. James concluded that in both forms is found:

The same sense of ineffable importance in the smallest events, the same texts and words coming with new meanings, the same voices and visions and leadings and missions, the same controlling by extraneous powers . It is evident that from the point of view of their psychological mechanism, the classic mysticism and these lower mysticisms spring from the same mental level, from that great subliminal or trans-marginal region of which science is beginning to admit the existence, but of which so little is really known. That region contains every kind of matter: ‘seraph and snake’ abide there side by side.[14]

Prince and Savage’s investigations also revealed a ‘plausible link’ between psychosis and mysticism.